Physical inactivity is an important risk factor for premature
morbidity and mortality, especially among high-risk populations.
Although
health-promotion programs have targeted high-risk groups (i.e.,
older
adults, women, and racial/ethnic minorities) (1), barriers exist
that may
affect their physical activity level (2). Identifying and reducing
specific
barriers (e.g., lack of knowledge of the health benefits of
physical
activity, limited access to facilities, low self-efficacy, and
environmental issues {2-6}) are important for efforts designed to
increase
physical activity. Concerns about neighborhood safety may be a
barrier to
physical activity (2,3). To characterize the association between
neighborhood safety and physical inactivity, CDC analyzed data from
the
1996 Behavioral Risk Factor Surveillance System (BRFSS) in
Maryland,
Montana, Ohio, Pennsylvania, and Virginia. This report summarizes
the
results of this analysis, which indicate that persons who perceived
their
neighborhood to be unsafe were more likely to be physically
inactive.

The BRFSS is a population-based, random-digit-dialed telephone
survey
of the civilian, noninstitutionalized U.S. population aged greater
than or
equal to 18 years. In 1996, data on physical activity were analyzed
for
12,767 persons (5320 men and 7447 women) who responded to the
Social
Context Module included in the 1996 surveys in Maryland, Montana,
Ohio,
Pennsylvania, and Virginia. Respondents were asked, "How safe from
crime do
you consider your neighborhood to be?" Possible responses were
"extremely
safe," "quite safe," "slightly safe," or "not at all safe."
Respondents
were classified as physically inactive if they reported no physical
activity or exercise during the preceding month. Numbers for
racial/ethnic
groups other than white were combined because, when analyzed
separately,
data were too small for meaningful analysis. Data were weighted,
and
standard errors were calculated using SUDAAN (7).

The prevalence of physical inactivity among respondents was
approximately 30% (n=3967), which is similar to the levels reported
for
adults in the United States (1). The prevalence of physical
inactivity was
highest among adults aged greater than or equal to 65 years, women,
racial/ethnic minorities, persons with a high school education or
less, and
persons with annual household incomes of less than $20,000
(Table_1).
Overall, higher levels of perceived neighborhood safety were
associated
with lower levels of physical inactivity; the differences were
greatest
among persons aged greater than or equal to 65 years (from 38.6%
{extremely
safe} to 63.1% {not at all safe}) and racial/ethnic minorities
(from 29.9%
{extremely safe} to 44.6% {not at all safe}). For respondents with
more
than a high school education, little difference in physical
inactivity was
noted among persons who perceived their neighborhood as unsafe and
persons
who perceived their neighborhood as safe (24.5% and 23.0%,
respectively).

The prevalence of physical inactivity among men and women
differed
across neighborhood safety levels among persons aged 18-64 years
but not
among persons aged greater than or equal to 65 years
(Figure_1). Data
stratified by age and sex and controlling for race and education
demonstrated an association between neighborhood safety and
physical
inactivity among older adults (odds ratio=2.3; 95% confidence
interval=1.1-4.7).

Editorial Note

Editorial Note: This report is the first to document the higher
prevalence
of physical inactivity among persons who perceive their
neighborhoods as
unsafe, and this finding remained after controlling for other
factors. The
findings were similar to those from other studies (1), which found
that
women were more physically inactive than men, and older adults were
more
inactive than younger adults. However, among older persons who
perceived
their neighborhoods as unsafe, the prevalence of physical
inactivity in
these states was similar among men and women.

Environmental barriers, including neighborhood safety, are not
the
only factors associated with physical inactivity among adolescents
and
young adults (3,8). However, many young adults use facilities, and
the
types of activities available are more varied. Among older adults,
environmental barriers studied have been related to access to
facilities
(e.g., malls, parks, and gymnasiums) for physical activity rather
than
neighborhood safety issues (4,5,9). Older adults, for whom walking
is the
major activity, may be more influenced by safety concerns in their
neighborhoods. These results suggest an association between
perceived
neighborhood safety and physical inactivity for adults aged greater
than or
equal to 65 years.

The findings in this report are subject to at least five
limitations.
First, BRFSS data are cross-sectional and may not accurately
reflect
behaviors or conditions over time. Second, data are from only five
states
and may not represent trends in other states. Third, because the
number of
respondents in this analysis is relatively small and the data are
self-reported, estimates may be unreliable. Fourth, because of the
small
number of respondents for racial/ethnic minorities, numbers were
combined
for a comparison with whites. Finally, these data may be affected
by
unmeasured confounding factors (e.g., social and demographic
factors).

The survey described in this report suggests that public
health action
is needed to provide safe alternatives for physical activity in
neighborhoods. Such efforts could increase community support and
access to
safe places for older adults to engage in physical activity.
Additional
research is needed to increase understanding of how perceived and
actual
neighborhood safety inhibits or facilitates participation in
physical
activity.

References

CDC. Physical activity and health: a report of the Surgeon
General.
Atlanta, Georgia: US Department of Health and Human Services,
CDC,
1996.

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